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Veteran facing lung cancer on his terms with hospice

By Pam Mellskog Longmont Times-Call

Posted:
11/10/2012 08:06:30 PM MST

Updated:
11/10/2012 08:08:53 PM MST

Hospice care for veterans

HospiceCare of Boulder and Broomfield Counties in 2011 was one of the first hospice organizations nationwide to earn Level 4 certification from the National Hospice and Palliative Care Organization in collaboration with the Department of Veterans Affairs for expertly meeting the needs of veterans and their families.

LONGMONT -- The Italian bartender in early 1945 sold Henry Yekel and his fellow off-duty U.S. Army Air Corps comrade Champagne corked in 1898 for just $6 a bottle.

Until the Americans arrived for R&R at the posh resort on Lido Island -- a 7-mile long promontory between the Adriatic Sea and Venice's lagoon -- the café hid the good stuff to deny it to the Germans at any price.

So, Yekel and his buddy sipped flute after flute of bubbly every night that week while on leave from Amendola Airfield at Foggia, Italy, where they served as gunners with the 97th bomb group, 340th bomb squadron.

Champagne gave them a taste of the good life.

Now, the 87-year-old World War II veteran, terminally ill with lung cancer, hopes for a good death -- for going out at home with his affairs in order, his pain managed, his "thank yous" and "farewells" expressed and his dignity as intact as possible.

To meet that goal, Yekel signed up on Sept. 24 with HospiceCare of Boulder and Broomfield Counties, a Lafayette-based nonprofit, end-of-life care provider that assigns each patient a care team that can include a doctor, a nurse, a certified nursing assistant, a social worker, a grief counselor and a chaplain.

"One of the most difficult things is showering with a young lady and actually taking a shower," Yekel joked. "We have been ingrained with modesty since we were children. ... But I'll clue you, when you can't do it yourself, modesty goes out the window."

Paperwork-wise, HospiceCare social worker Charley Rosicky helped him sort out insurance coverage within an hour and saved Yekel an estimated $8,000 to $15,000.

The little things count, too.

When his oxygen machine made too much noise and kicked off too much heat, the care team immediately replaced it.

When Yekel got bedsores, the nurse brought gel cushions.

"It may not sound very important. But when your butt hurts, it's hard to sleep," he said.

Nevertheless, because American culture treats death as a taboo subject, HospiceCare statistics show that most dying people wait to make the call just a few days before they die, according to HospiceCare spokeswoman, Mary Chokran.

"They think that we want them to just throw in the towel," she said. "So, they put this off as long as possible even though our services can help someone make the most of their life before it ends."

Countering morphine myths

Part of that resistance comes from the belief that hospice can only offer a single tool, morphine, and that both doctor and patient somehow fail if they accept death for what it is -- a natural part of life, Dr. John Massone, HospiceCare's medical director, said.

"Culturally, we're taught to seek more care. ... And it is a big step to help someone understand why getting another CT scan or another surgery might not be to their benefit," he said. "But we can reduce the trauma on the patient and their family by reducing the medical adventures that they take."

Massone cited research that shows how a so-called bad death, one characterized by trauma related to both poor pain management and communication, can negatively impact the health of survivors.

"It is certainly quite sobering to see how (that kind of death) can reverberate beyond the patient. ... The more we can think ahead, the less the patient and their families will suffer," he said.

"When the body is shutting down, it is running out of energy, and eating takes energy. So, I explain that it is OK to not eat, that caregivers are not failing their loved one by not forcing them to eat," she said.

"The problem is that when we get patients very close to the end, there's no time for these conversations. It's mostly just a medical crisis when the patient could have had a soft landing."

Making choices to the end

Some folks -- be they combat veterans or civilians -- have no say about how they die.

"I've been living on borrowed time since I was 19," Yekel said, referring to the 30 missions he flew over enemy territory, each one of them with a 30 percent safe return rate.

"Still, this is not how I wanted to check out. My fantasy was to be shot in bed by a jealous husband," he said, smiling at Mary Yekel, his 85-year-old wife of 67 years. "As you can see, I still have my sense of humor."

By inviting HospiceCare's team into his apartment at the Longmont Regent Independent Senior Living Community, he can live with her, the woman he met in 1944 at a bowling alley in Lincoln, Neb., before deploying.

Yekel's chest back then measured 44 inches and his waist 29 inches.

"Unfortunately, now it's the other way around," he said.

While a long life may rob the body, and in some cases the mind, Yekel relished naming the spoils of many years -- namely, his wife; their three grown children, four grandchildren and seven great grandchildren; and his long career in civil service with the Department of Commerce.

"... And now is my time, and you accept it as being what God wanted. ... If you can accept it as normal, you won't be mentally or morally disturbed. (You can) make peace with yourself," he said.

Conversation causes Yekel to hack and discreetly spit in a cup on the floor beside his reclining chair.

"A speedy death is preferable. Mine isn't preferable. It's boring. Sorry. That's the way it is," Yekel said. "But neither Mary or I are cramming for our finals. We've passed the test of life as we've lived."

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